FROM BENCH TO BEHAVIOUR. International experience with evidence dissemination about HTA Aine Heaney NPS Medicinewise

Transcription

1 FROM BENCH TO BEHAVIOUR International experience with evidence dissemination about HTA Aine Heaney NPS Medicinewise

2 THE LAND DOWN UNDER

3 PHARM NATIONAL MEDICINES POLICY NPS

4 WHO IS NPS MEDICINEWISE? Established as the National Prescribing Service Limited in 1998 Independent, not-for-profit organisation Funded by the Australian Government Membership based Work in partnership Dr Lynn Weekes Chief Executive Officer, NPS, since consumers - health professionals - government - industry Broader program of work and have expanded into medical tests

5 WORLD HEALTH ASSEMBLY RESOLUTION The resolution at the 60th World Health Assembly in 2007, urged member states: to establish a national multidisciplinary program to monitor and promote the rational use of medicine to develop rational drug use training programs for health professionals, students and the public to develop and implement national policies and programs for improving use of medicines, with an emphasis on multifaceted interventions targeting both the public and private health sectors, and involving providers and consumers to develop the capacity of hospital drug and therapeutic committees to promote QUM.

6 FACTORS FOR SUCCESS National Medicines Policy gives legitimacy and enduring tenure to our activities Operational and editorial independence Accuracy of information, evidence-based Sound rationale for approach to changing practice Demonstration of achievements on quality and savings Engagement with stakeholders, broad partnerships Trust and perception of value by stakeholders

7 KEY CHALLENGES FACING OUR HEALTH SYSTEM meeting the needs of a growing and ageing population rapid advances in scientific and technical capacity new medicines including biologicals and personalised medicines managing the growing prevalence of chronic and complex conditions/ multimorbidity escalation in consumer knowledge and their expectations of the health service increasing cost of health care

8 IMPROVING HEALTHCARE IS A TEAM SPORT

9 BARRIERS TO HTA ADOPTION Drowning in comparative effectiveness data Flawed underlying assumptions No effective dissemination plans CME/CPD is largely driven/paid for by sponsors (e.g Big Pharma) Marketing strategies/tactics blur evidence Physician resistance

10 SOLUTIONS Have early & robust plans for dissemination Improve clinician education (independent) Use health information technology (e.g. RADAR) Limit promotional claims (self regulate?) Address physician resistance Introduce quality control measures (e.g. credentialling) Employ effective, evidence based techniques to behaviour change e.g. academic detailing

11 ACADEMIC DETAILING A one-to-one, clinician-to-clinician, onsite, interactive, educational outreach session to disseminate scientifically supported clinical evidence with the intention of improving the healthcare of a population 3 topics per year Recent topics have covered dementia, newer anticoagulants, asthma management in kids, health checks, diabetes

12 DESIGN Formative research Market research Advisory groups Reconnaissance Program logic Objectives Expected outcomes Key messages Focus/scope Evaluation plan

13 MULTI-FACETED INTERVENTIONS Expert advisory groups Key informants Studies Drug use data ADEs Phone Line enquiries Clear objectives defined Key messages identified Print materials Academic detailing Patient tools Consumer campaigns Audit and feedback System change

14 SUPPORT Training Background reading Detailing materials and script Topic training and rehearsal Clinical lead for FAQs/queries Network support Media and marketing

15 DELIVERY National coordination local implementation Mostly part time pharmacists >50% of all GPs participate every year 1-to-1 and small group sessions Average visit is 38mins (10min wait) Wrap other services around e.g. community pharmacists, practice nurses, local communities

16 WHAT IS NEEDED FOR SUCCESS Funding model relies on interested 3 rd parties Meaningful & feasible for doctors (right place, right time) - Safety concerns (e.g. glitazones, NOACs) - Switching, reduction vs cessation (e.g. PPIs) - Less entrenched behaviours - Suitable alternatives (e.g. depression/cbt) - Clear action Need to translate scientific advances into useable information for clinicians and patients

17 EXAMPLE OF NATIONAL PROGRAM

18 PRESCRIBING EVALUATION: CHOLINESTERASE INHIBITORS & MEMANTINE Model of data over time with the NPS intervention effect removed (predicted) Model of actual data over time with the NPS intervention

19 FINANCIAL AND ECONOMIC Cost per visit PBS savings of >80MIL per year Health outcomes

20 WHAT IS NEEDED FOR SUCCESS Local champions Well trained & supported educators Support staff who really understand primary care Collateral programs & products Programs tailored to GP workflow and business needs

21 WHAT WORKS REALLY WELL Workforce Support staff National coverage Local relevance Trusted & respected Visit duration Clinicians are hungry for unbiased, balanced information from a credible source Jerry Avorn.

22 WEAKNESSES Monitoring quality & efficiency Ability to deploy workforce in other settings Maintaining corporate knowledge Branding 30% of GPs don t take part

23 OPPORTUNITIES & CHALLENGES Asked to take on more ( topics, complexity) Specialist prescribers Aged care Corporate practices Health reforms Understanding value

24 IN SUMMARY ACADEMIC DETAILING Moves interaction beyond communicating just information brings the best available evidence to the place at which care is delivered and can be tailored to the level of knowledge, interest and responsibility of the person visited Involves understanding existing behaviour what are the key motivations and barriers for current behaviour Understands where people are currently at what people feel/think about the issue - not where you want them to be Focuses on how to encourage and achieve voluntary action not about coercion or enforcement Influences knowledge, behaviour and attitudes

25 CONCLUSION Effective national program Maintain commitment to effective evidence based interventions Improve efficiency Get to those hard to reach Constant change & innovation in health care